Practice Test 2
Which of the following is not a cause for hyperkalemia in children?
- Addison’s disease
- Acute renal failure
- RTA type IV
- Conn’s disease
Correct Answer : E. Conn’s disease
The causes of hyperkalemia in children include renal failure, renal tubular disease, Addison’s disease, crush injury burns, hypoaldosteronism, hemolysis, RTA type IV, acidosis, diabetic ketoacidosis, and insulin deficiency. Conn’s disease does not cause hyperkalemia in children.
In neonatal resuscitation, what would be the first action by a nurse?
- Wipe the neonate with a wet towel.
- Place the neonate on back.
- Suction the nose.
- Suction the mouth.
- Suction the oropharynx.
Correct Answer : B. Place the neonate on back.
Immediately following the delivery, the neonatal nurse must begin a process of assessment, planning and action. The neonate must be first placed on back in a warming table. The next step is drying the neonate completely and placing the neonate with head in midline position and slight neck extension. Later mouth, oropharynx and nose are suctioned by the nurse.
How is the length of the feeding tube to be inserted for trans-pyloric feeding in a neonate measured?
- Ear lobe to umbilicus
- Nose to umbilicus
- Nose to Knee
- Earlobe to knee
- Ear to knee
Correct Answer : C. Nose to Knee
In trans-pyloric feeding, the feeding tube’s length is measured from the tip of the neonate’s nose to knee. It is passed inside as in the same manner as for gavages feeding. PH must be >5 and the color of aspiration must be yellow for verification, after the tube placement. The other above-mentioned tube length measurement sites are not used in trans-pyloric feeding.
A nurse cares for a 7 months old infant. When the nurse assesses for the sodium loss in the infant, which of the following should be considered as the earliest indicator of sodium loss?
- Reduced skin turgor
- Altered sensorium
- Orthostatic hypotension
Correct Answer : C. Altered sensorium
If serum sodium concentration is <120 mEq/L, the infants develop symptoms of nausea, vomiting, irritability and restlessness. There is a fluid shift from ECF to neural cells. This results in cerebral edema which causes headache, seizures, drowsiness and coma. The other above-mentioned symptoms are not present in hyponatremia.
Which of the following is considered as the primary goal in neonatal resuscitation by a nurse?
- Maintaining breathing
- Retaining color
- Inducing spontaneous cry
- Restoring heart rate
- Reducing pallor
Correct Answer : A. Maintaining breathing
Initially, the nurse must assess whether the neonate is breathing spontaneously; if he is not then the nurse has to maintain breathing in the neonate. Later, the nurse must assess whether the heart rate is greater than 100 beats per min. Finally, the nurse can evaluate whether the neonate’s overall color is pink.
When a nurse assists in endo-tracheal tube insertion, what would be considered as the tube insertion level?
- 5cm above xiphisternum
- 4cm above carina
- 1cm above carina
- At carina
- Below carina
Correct Answer : C. 1cm above carina
Half way between the vocal cord and carina is considered as the appropriate level of endo-tracheal tube insertion, which is located exactly 1 cm above carina. This can be confirmed by chest x-ray. If it is inserted beyond the carina, the tip of the tracheal tube is likely to be within the right main broncus. This is a situation known as a "right main stem intubation". In this situation, the left lung may be unable to participate in ventilation, which can lead to decreased oxygenation, due to ventilation/perfusion mismatch. The other above-mentioned locations are not correct for the tube insertion.
A one-month-old infant who was born at term without any complications was eating well and was gaining weight in the first 3 weeks of birth. In the 4th week, the infant appears hungry but gets tired when fed. At present, he takes twice as long to complete his feeding, as he did 1 week ago. He has tachycardia, during feedings. Which of the following diseases is the infant likely to be suffering from?
- Aspiration syndrome
- Congestive heart failure
- Gastro-esophageal reflux disease
- Inborn error of metabolism
Correct Answer : B. Congestive heart failure
The symptoms in this infant are typical of progressive congestive heart failure. Poor feeding is due to his inability to generate a prolonged suck. Tachypnea is caused by pulmonary congestion. Decreased caloric intake with increased caloric expenditure is caused by tachypnea and tachycardia. This makes it difficult for the infant to gain weight. Weight loss is common in infants who have CHF. The other above-mentioned diseases do not have the features mentioned in the infant described.
Which is the most appropriate site to check the pulse in a one month old infant?
Correct Answer : B. Brachial
Brachial pulse is considered as the most appropriate pulse to be checked in a one month infant. Brachial pulse is easily palpable in infants. The infant’s neck is short and fat, so the carotid pulse is not considered appropriate. Popliteal, radial and femoral are difficult to palpate. It requires a lot of practice to assess the other above-mentioned pulse sites.
A nurse cares for a 1 year old male child who is diagnosed with bronchiolitis. Which of the following is the best method of assessing dehydration in the child?
- Assessment of the fontanels
- Assessment of the oral mucosa
- Maintenance of intake and output chart
- Checking the weight daily
- Assessing the skin turgor
Correct Answer : : D. Checking the weight daily
Weight is the best indicator of fluid loss or gain. If one kg of weight is lost, it represents one liter of fluid loss. This shows that checking the weight on a daily basis is the best and the most reliable way for finding out the dehydration status. The other above-mentioned methods are used after checking the weight of the infant.
A nurse is caring for a child who is diagnosed to have epiglottitis. On assessment, which of the following would indicate that the child is experiencing airway obstruction?
- Child leaning forward with the chin thrust out
- Child leaning backwards
- Child with low-grade fever
- Child lying on the bed
- Child with bradycardia
Correct Answer : A. Child leaning forward with the chin thrust out
Child leaning forward with the chin thrust out is an indication of airway obstruction. Symptoms of airway obstruction include tripod positioning which is: leaning forward with supported arms, chin thrusted out and the mouth open. The child also has features of nasal flaring, tachycardia, high fever, and sore throat when affected with epiglottitis. The child will not lean backwards, as it is an inconvenient position during airway obstruction. Low-grade fever and bradycardia are incorrect, because epiglottitis causes high fever and tachycardia. A child with airway obstruction will not lie on the bed but would insist upon sitting on the bed during epiglottitis.
A 2-year-old male child is diagnosed with tetralogy of fallot. He looks upset, cries aloud and gets violent during blood sample collection. The child suddenly develops cyanosis; his respiratory rate was found to be 46 beats per minute. Which of the following nursing actions would be considered appropriate by the nurse first?
- Positioning the child in knee-to-chest
- Telling the child that it will pain only for a short time
- Monitoring for the irregular heart rate
- Sedating the child as prescribed
- Placing the child in supine position
Correct Answer : A. Positioning the child in knee-to-chest
The child suffers from hypoxia. The nurse can position the child in a knee-to-chest position. Flexing the knees to the chest decreases venous blood flow. This position decreases the amount of blood passing in the inter-ventricular septal defect. This blood later enters the systemic circulation and there the oxygen concentration becomes higher. Hence, the dyspnea is managed. Drawing the knees to chest increases vascular resistance along with the left ventricular pressure. The child must not be positioned in supine. After positioning the child in knee-to-chest, the nurse can monitor for irregular heart rate. If positioning alone cannot alleviate the child’s dyspnea, then the child can be sedated as prescribed. Telling the child that it will only pain for a short time will not stop hypoxia.
When a mantoux test is performed in a 3-year-old child, which of the following induration measurements would reveal a positive test?
- 5 mm
- 10 mm
- 15 mm
- Greater than 5mm
- Greater than 15mm
Correct Answer : B. 10 mm
Induration measurement of 10mm indicates a positive result in children who are less than 4 years old. Induration measurement of 5 mm or greater indicates a positive result in high risk patients such as patients having HIV infection. Induration measurement of greater than 15 mm indicates a positive result for children older than 4 years or patients with no high risk for T.B.
A nurse cares for a 5-year-old child affected with respiratory syncytial virus. The child is prescribed ribavirin. Which is considered as the most appropriate route for the nurse to administer this medication?
- Oxygen tent
Correct Answer : D. Oxygen tent
The most appropriate route of administering the antiviral drug ribavirin is through oxygen tent. This drug is prescribed in children with severe RSV. Other routes of administering ribavirin are through head-hood and face mask. The other above-mentioned routes are not considered as appropriate in case of children with severe RSV.
A nurse cares for a child with acute exacerbation of asthma. Which of the following indicates the worsening of this condition?
- Increased wheezing
- Pink dry skin
- Decreased wheezing
- Increased respiratory effort
- Pulsus alternans
Correct Answer : C. Decreased wheezing
Decreased wheezing indicates the worsening of acute exacerbation of asthma. It also shows that the child is unable to move air. With treatment, increased wheezing indicates improvement in child’s condition. In acute exacerbation of asthma, cyanosis of skin is seen. Poor respiratory effort is seen in such a life-threatening situation. Paradoxical pulse is seen in acute exacerbation of asthma.
A nurse cares for a 3-year-old child with croup. One of the following signs and symptoms is not correct about croup. Which is it?
- Worsening symptoms at both day and night
- Worsening symptoms at day and improvement during sleep
- Harsh cough
- Inspiratory stridor
- Brassy cough
Correct Answer : B. Worsening symptoms at day and improvement during sleep
Children with croup will have worst symptoms during sleep and condition will become better during daytime. After several days of respiratory infection the child develops croup. Along with sore throat and fever, the child will have all other above-mentioned signs and symptoms in croup.